AB0471 FEASIBILITY STUDY OF METHOTREXATE USE IMPROVEMENT IN RHEUMATOID ARTHRITIS (MIRA) USING BIOMARKER FEEDBACK: QUALITATIVE RESULTS FROM PATIENT INTERVIEWS
Authors: J. Bluett, P. Doran, K. Hyrich, B. Keevil, A. Barton
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> MTX non-adherence is associated with reduced response, increased healthcare costs to the NHS and reduced quality of life for the patient. Often the prescriber is unable to determine if a patient is taking their medication as prescribed. There is a need to measure adherence directly to facilitate more precise and objective measurements of adherence to add to the clinicians tools and help to open up honest discussions and supportive interventions with patients. Our group has previously developed a sensitive biochemical assay for the detection of MTX adherence, MIRA is a feasibility trial designed to assess the feasibility of a randomised controlled trial of MTX biochemical adherence biofeedback. This paper reports on the patients' perspectives on adherence monitoring. <h3>Objectives</h3> MIRA is a prospective multi-centre randomised controlled trial to examine the feasibility of a fully powered randomised controlled trial to examine if a biochemical adherence guided intervention is superior to standard clinical care in RA patients prescribed MTX. <h3>Methods</h3> RA patients prescribed oral MTX for ≥ two years were randomised 1:1 to receive biochemical adherence biofeedback or control. Clinico-demographics, biochemical MTX adherence and DAS-28 and were measured at baseline and three months. Participants in the intervention cohort were telephoned with their biochemical adherence results and adherence was explored. The semi-structured interviews were used to evaluate a sample of patient perspectives about and engagement with the intervention (n=10, visit 4). Ethical approval for MIRA was given by the North West - Haydock Research Ethics Committee (19/NW/0047) and all participants provided written informed consent. <h3>Results</h3> 57 trial participants were recruited, withdrawal rate was 14% and reasons given were intercurrent illness, lost contact, withdrawn consent and one patient died during follow-up leaving full outcome data available for 49 participants. A total of nine semi-structured interviews were recorded and analysed in the qualitative arm of the study. The themes from the interviews were grouped in relation to the core concepts of normalisation process theory, these were: coherence, cognitive participation, collective action, reflexive monitoring. Density mapping of the themes suggested that <i>comprehension</i> of the study purpose might have been limited. However, there were high levels of <i>reflexive monitoring</i> and most of the reflections were of a positive nature. Additionally, the intensity of data relating to <i>cognitive participation</i> and <i>collective action</i> suggest that participants were fully engaged in the trial and were supportive of the intervention and trial process. <h3>Conclusion</h3> The results of the MIRA trial have demonstrated that the use of a biochemical adherence blood test with biofeedback is feasible as part of a clinical trial. Qualitative findings suggested that participants reported that they were happy to take part in the trial. In contrast to expectations, participants were happy to have their MTX adherence monitored. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.